19 Mar Low-Value Care in Traditional Fee-for-Service Medicare vs Medicare Advantage
MedicalResearch.com Interview with:
Sungchul Park, MPH PhD
Assistant Professor, Health Management and Policy
Dornsife School of Public Health
Philadelphia, PA 19104
MedicalResearch.com: What is the background for this study?
Response: Evidence suggests that a significant share of health care costs in the US is of low value. In some cases, low-value care can be associated with harmful patient outcomes. Thus, decreasing use of low-value care is a major goal for Medicare given the potential to decrease costs and harms. Compared with traditional fee-for-service Medicare (TM), Medicare Advantage (MA) is more strongly financially incentivized to decrease use of low-value care.
MedicalResearch.com: How is low-value care determined?
Response: We identified 13 low-value services in 4 categories based on evidence-based guidelines identifying low-value care.
MedicalResearch.com: What are the main findings?
Response: We found two key findings. First, use of low-value care was similarly prevalent in Medicare Advantage and TM, suggesting that managed care enrollment is not associated with decreased use of low-value care. Second, there was little evidence for decreases in use of low-value care in TM and MA between 2006 and 2015.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings suggest that neither the current structure of the TM and Medicare Advantage programs not recent efforts to decrease use of low-value care have been associated with significant outcomes.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Despite this limited finding overall, two other findings were notable. First, decreasing rates in the low-value cancer screening composite measure in both programs were of interest. Second, MA enrollees had a higher likelihood of having a low-value imaging composite use compared to TM enrollees in 2006-07, but low-value imaging composite rates remained lower among MA enrollees in later years. Further research is needed to understand the underlying mechanisms for these findings.
Park S, Jung J, Burke RE, Larson EB. Trends in Use of Low-Value Care in Traditional Fee-for-Service Medicare and Medicare Advantage. JAMA Netw Open. 2021;4(3):e211762. doi:10.1001/jamanetworkopen.2021.1762
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